44 (44)    MH REPORT (601.93)

.|.|TIDES Depression Follow-Up Assessment||Date Given: <.Date_Given.>|Clinician: <.Staff_Ordered_By.>|Location: <.Location.>||Veteran: <.Patient_Name_Last_First.>|SSN: <.Patient_SSN.>|DOB: 
that apply):|    <*Answer_4303*>|14. Risk Assessment/Management comments:|    <*Answer_4305*>|15. Patient currently on antidepressant?|    <*Answer_4313*>|16. Patient taking antidepressant as 
directed?|    <*Answer_4314*>|17. Last filled Rx:|    <*Answer_4315*>|18. Any side-effects from antidepressant?|    <*Answer_4316*>|19. Intensity of side-effects:|    <*Answer_4317*>|20. 
Side-effect(s) from antidepressant (Check all that apply):|    <*Answer_4318*>|21. Antidepressant changes by provider:|    <*Answer_4489*>|22. Comments on medication compliance and side-effects|    
<*Answer_4319*>|23. How often does the patient drink?|    <*Answer_4331*>|24. Drinks per day:|    <*Answer_4334*>|25. Number of days in a month when patient has five or more drinks:|    
<*Answer_4335*>|26. Does patient want alcohol treatment?|    <*Answer_4336*>|27. Patient reports significant drug abuse?|    <*Answer_4338*>|28. Since the last assessment, has patient felt anxious, 
frightened or had panic attack(s)?|    <*Answer_4340*>|29. Does the patient want a referral for anxiety/panic symptoms?|    <*Answer_4341*>|30. PTSD factors (Check all that apply):|    
<*Answer_4343*>|31. Referral for PTSD treatment:|    <*Answer_4344*>|32. Comments regarding co-morbidity:|    <*Answer_4347*>|33. Previously sent material:|    <*Answer_4473*>|34. Self-Help Plan in 
place?|    <*Answer_4474*>|35. Is patient doing self-help activities?|    <*Answer_4475*>|36. Changes in barriers to learning (Check all that apply):|    <*Answer_4478*>|37. Information offered and 
encouragement (Check all that apply):|    <*Answer_4476*>|38. Information to be mailed (Check all that apply):|    <*Answer_4477*>|39. Number of Primary Care appointments since last DCM assessment: 
(If no appts between DCM assessments, or clinic cancelled appt, enter zero.)|    <*Answer_4490*>|40. Number of Primary Care appointments kept: (Do not count walk-in appointments.)|    
<.Patient_Date_Of_Birth.> (<.Patient_Age.>)|Gender: <.Patient_Gender.>||Today's Date:|    <*Answer_4499*>|1. The patient is feeling:|    <*Answer_4487*>|2. Weeks since initial TIDES assessment:|    
<*Answer_4491*>|41. Has an upcoming Primary Care visit been scheduled?|    <*Answer_4492*>|42. Date of next scheduled Primary Care visit:|    <*Answer_4493*>|43. Number of mental health appointments 
since last assessment: (If no appts between DCM assessments, or clinic cancelled appt, enter zero.)|    <*Answer_4494*>|44. Number of mental health appointments kept:|    <*Answer_4495*>|45. Has an 
upcoming mental health visit been scheduled?|    <*Answer_4496*>|46. Date of next scheduled mental health visit:|    <*Answer_4497*>|47. Mental health appointment types:|    <*Answer_4498*>|48. 
Comments on self-help and compliance:|    <*Answer_4480*>|49. Contact with family indicated?|    <*Answer_4500*>|50. Family contact goals (Check all that apply):|    <*Answer_4501*>|51. Has patient 
consented to family contact?|    <*Answer_4502*>|52. Care Manager contact since last encounter?|    <*Answer_4503*>|53. Number or contacts since last patient assessment:|    <*Answer_4504*>|54. Care 
Manager had contact with (Check all that apply):|    <*Answer_4505*>|55. Discussed with family members:|    <*Answer_4506*>|56. Impact on patient's depression care?|    <*Answer_4507*>|57. Future 
family contact planned?|    <*Answer_4508*>|58. Comments for family involvement:|    <*Answer_4509*>|59. Depression Care Panel status:|    <*Answer_4554*>|60. Depression follow-up in:|    
<*Answer_4511*>|59. Depression Care Panel status:|    <*Answer_4553*>|62. Comments for Care Manager follow-up:|    <*Answer_4512*>|63. Patient questions and concerns:|    <*Answer_4513*>|64. Care 
Plan suggestions (Check all that apply):|    <*Answer_4514*>|65. Suggested labs:|    <*Answer_4515*>|66. Was case discussed with supervisory psychiatrist?|    <*Answer_4516*>|67. Supervising 
psychiatrist input:|    <*Answer_4517*>|68. Care Manager comments:|    <*Answer_4518*>|69. Patient knows no more calls are coming?|    <*Answer_4519*>|70. Patient knows to continue medication(s)?|    
<*Answer_4488*>|3. Most recent PHQ-9: Declined or could not do.|    <*Answer_4290*>|4. Most recent PHQ-9 score:|    <*Answer_4291*>|5a. Little interest or pleasure:|    <*Answer_4543*>|5b. Feeling 
<*Answer_4520*>|71. Relapse strategies discussed (Check all that apply):|    <*Answer_4521*>|72. Suggested clinician follow-up (Check all that apply):|    <*Answer_4522*>|73. Future Care Manager 
follow-up (Check all that apply):|    <*Answer_4523*>|74. Patient's discharge comments:|    <*Answer_4524*>|75. Patient discharge discussed with mental health?|    <*Answer_4525*>|76. Psychiatrist's 
input on patient discharge|    <*Answer_4526*>|77. Care Manager's comments on patient discharge:|    <*Answer_4527*>|78. Depression diagnosis in problem list or CPT?|    <*Answer_4528*>|79. 
Depression diagnosis, ICD-9:|    <*Answer_4529*>|80. Provider feedback to:|    <*Answer_4530*>|81. Encounter type:|    <*Answer_4531*>|82. Encounter length:|    <*Answer_4533*>|83. Call history: The 
number of attempts to reach the patient for this assessment:|    <*Answer_4532*>|    $~
down, depressed or hopeless:|    <*Answer_4544*>|5c. Trouble falling or staying asleep; or sleeping too much:|    <*Answer_4545*>|Sleep disturbance:|    <*Answer_4293*>|5d. Feeling tired or having 
little energy:|    <*Answer_4546*>|5e. Poor appetite or overeating:|    <*Answer_4547*>|Appetite disturbance:|    <*Answer_4294*>|5f. Feeling bad about yourself:|    <*Answer_4548*>|5g. Trouble 
concentrating on things:|    <*Answer_4549*>|5h. Moving or speaking slowly; or being fidgety or restless|    <*Answer_4550*>|Psycho-motor disturbance:|    <*Answer_4295*>|5i. Thoughts that you would 
be better off dead or of hurting yourself in some way.|    <*Answer_4551*>|6. Number of symptoms present:|    <*Answer_4296*>|7. Major Depression Disorder trigger symptoms:|    <*Answer_4297*>|8. 
Symptom Difficulty:  Symptoms make work/home/getting along difficult?|    <*Answer_4298*>|9. Comments on depression screening:|    <*Answer_4299*>|10. Suicidial ideation (Check all that apply):|    
<*Answer_4300*>|11. Other risk factors for suicide (Check all that apply):|    <*Answer_4301*>|12. Is the VA suicide policy initiated?|    <*Answer_4302*>|13. Suicidal ideation management (Check all